Victor Montori at the Mayo Clinic says that 'minimally disruptive medicine' can lead to better health—and lower costs

Victor Montori,
who explores new methods of treating chronic illness, is generating a lot of discussion with one idea: that one of the best strategies, especially for patients with more than one chronic condition, is for their care providers to back off a little. Give them some breathing room.

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As an endocrinologist, Dr. Montori specializes in diabetes, one of the most prevalent and costly of chronic diseases. But as director of the Health Care Delivery Research Program at the Mayo Clinic in Rochester, Minn., he focuses on innovative ways to improve care for all chronic illness, which taken together represents the leading cause of death and disability in the U.S.

Care for such diseases is often so complex, Dr. Montori says, it overwhelms patients and makes it hard for them to follow their regimens. His solution—minimally disruptive medicine—is gaining interest among health-care quality groups and policy makers. Here are edited excerpts from an interview with The Wall Street Journal:

Patients' Capacity

WSJ: What is minimally disruptive medicine?

ENLARGE

Victor Montori says care for chronic diseases is often so complex that it overwhelms patients.
Mayo Clinic

DR. MONTORI: It is health care designed to achieve the goals of patients while imposing the smallest possible footprint on their lives. Patients and clinicians can work together in deciding which treatments to take, prioritizing those most likely to help our patients achieve their goals and dreams. Then, we need to deliver these treatments in a way that is mindful of the work required and patients's capacity to get this work done.

WSJ: How is medicine practiced in a disruptive way now?

DR. MONTORI: The pressure is on to make sure patients receive all the tests and treatments they need. That means going to the doctor's office, the lab and the pharmacy, completing paperwork and phone calls, dealing with staff at these facilities and with insurance and approvals.

If you have only one chronic condition, that is work you can probably fit into your life. But if you have multiple chronic conditions and a complex life, it is hard to fit all of this work into your day.

WSJ: How much is the current system of measuring quality of care to blame?

DR. MONTORI: Health-care systems and doctors are not being recognized for simplifying the schedule or reducing the number of visits and tests. We don't have any guidelines or quality-of-care measures for that. So, doctors are placed in a conflicted position: to focus on what matters to patients and fits [the specific situation], or to satisfy these quality-of-care measures? We have to give clinicians permission to refocus on what is important for patients and deliver it in ways that fit their context.

DR. MONTORI:Care that fails to deliver better health, greater ability of patients to fulfill their duties and pursue their dreams, is wasteful and should be eliminated. Care requiring patient work that patients cannot implement will be wasted.

Patients with multiple chronic conditions are particularly at risk for overwhelming care. For these patients, who represent about 5% of all patients and yet account for about 40% of all health-care costs and service consumption, getting less care, but getting care they need, want and can implement, would offer better value. The opposite, of course, is true for people who get less care than they need.

Quality of Life

WSJ: How are you putting these ideas into practice at the Mayo Clinic?

DR. MONTORI: For now, it is a four-pronged approach to the care of patients with many chronic conditions.

Like everyone else, we are working actively on care coordination.

We are also working to ensure we know what matters to patients. What patients really want is often not to have better blood pressure or lower cholesterol. What they usually want is to feel better, not die before their time, and be able to do what they need to do to fulfill their obligations and pursue their dreams. We must commit to work toward our patients' goals.

Then, we are implementing shared decision-making, using point-of-care tools that help with issues such as which medicine to take for diabetes or whether to take statins or aspirin to reduce the risk of heart attack.

Finally, we are working hard to understand patients' capacity. We are testing an approach to uncover patient's health literacy and resilience; their mental, physical, and financial health; the quality of their support network and of the environment in which they live. We want to know what resources they have which can be optimized to face the complexity of caring for their conditions.

Enhancing capacity and reducing workload can help patients access, use, and enact the care they need and want. This care will not be wasted.

Ms. Landro is an assistant managing editor for The Wall Street Journal and writes the paper's Informed Patient column. She can be reached at laura.landro@wsj.com.

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